rifampin and Purpura--Thrombocytopenic--Idiopathic

Drug-induced thrombocytopenia occurs through immune-mediated platelet destruction, and its management is challenging during tuberculosis treatment. Although rifampicin is the most common drug causing thrombocytopenia, isoniazid can also cause thrombocytopenia. We herein report a 75-year-old man who developed thrombocytopenia during tuberculosis treatment. Platelet-associated immunoglobulin G and a drug-induced lymphocyte stimulation test for isoniazid were positive; no other causes of thrombocytopenia were identified. The patient was diagnosed with isoniazid-induced immune thrombocytopenia, and the platelet count normalized after isoniazid discontinuation. We describe the immunological mechanism of thrombocytosis due to isoniazid, an uncommon cause of thrombocytopenia that physicians should be aware exists.

Topics: Aged; Humans; Isoniazid; Male; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Thrombocytopenia

Topics: Aged; Antibiotics, Antitubercular; Humans; Male; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Tuberculosis, Gastrointestinal

Topics: Animals; Blood Platelets; Glucocorticoids; Humans; Immunoglobulins, Intravenous; Methylprednisolone; Mice, Inbred NOD; Mice, SCID; Platelet Glycoprotein GPIIb-IIIa Complex; Purpura, Thrombocytopenic, Idiopathic; Rifampin

Topics: Antibiotics, Antitubercular; Female; Humans; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Tuberculosis, Pulmonary

Thrombocytopenia induced by rifampicin in the absence of prior sensitization is exceptional, especially when it occurs in a patient without risk factors. We report the case of a patient aged 25 years with no past history of medical, surgical or knowledge of having taken rifampicin previously, who was hospitalized for treatment of thrombocytopenic purpura occurring after the initiation of fixed combination quadruple therapy (isoniazid, rifampicin, pyrazinamide and ethambutol) for pulmonary tuberculosis. The biological pretreatment and therapeutic education had not been made. The patient presented with thrombocytopenic purpura 30000/mm(3) on day 9 after the initiation of treatment. The platelet count returned to normal 10 days after discontinuation of treatment. We elected not to reintroduce rifampicin given the strong likelihood that it was responsible for this complication. We conducted a phased reintroduction of isoniazid, ethambutol and pyrazinamide. No recurrence of the thrombocytopenia occurred. Thus, the diagnosis of rifampicin-induced thrombocytopenia appears to have been confirmed and the patient tolerated the remainder of their treatment well.

Topics: Adult; Antibiotics, Antitubercular; Ethambutol; Female; Humans; Immunization; Isoniazid; Purpura, Thrombocytopenic, Idiopathic; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary

A 49-year-old man was admitted to the hospital with complaints of fatigue, epistaxis and a skin rash. The whole blood count revealed isolated thrombocytopenia (4,000/mL), and the patient was admitted to the hematology department with a diagnosis of immune thrombocytopenia. He did not respond to steroid treatment for 15 days, and a subfebrile fever developed during this period. A diagnosis of acute brucellosis was considered due to positive serological tests and a blood culture positive for Brucella spp. After starting doxycycline and rifampicin therapy, the patient's thrombocyte count increased to 15,000/mL on the third day, to 41,000/mL on the sixth day and was normal on the 21st day of treatment. A diagnosis of brucellosis must be considered in patients presenting with severe and isolated thrombocytopenia in countries where brucellosis is endemic.

Topics: Animals; Anti-Bacterial Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Humans; Male; Middle Aged; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Thrombocytopenia; Turkey; Zoonoses

Brucellosis, a common disease in some areas of the world, beside its typical signs and symptoms, as fever, arthropathy, hepatomegaly and splenomegaly, sometimes can complicate into thrombocytopenia, even in severe forms. The pathogenesis of thrombocytopenia in course of brucellosis is variable, and a main role is played by immunological reactions. Authors describe a case report of an eight years child who presented a severe thrombocytopenia in course of acute brucellosis. The patient responded efficaciously to the antibiotic therapy combined with immunoglobulin intravenous therapy.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Cheese; Child; Combined Modality Therapy; Doxycycline; Food Contamination; Food Microbiology; Humans; Immunoglobulins, Intravenous; Male; Purpura, Thrombocytopenic, Idiopathic; Rifampin

Drug-induced thrombocytopenia is a challenging diagnosis in the clinical practice because of the many drugs or alternative causes that may be implicated. Exact identification of such drug(s) is required to guide future management and avoid re-exposure. We describe two cases of isolated thrombocytopenia in which cytometric analysis, a readily available technique, allowed the identification of the causative drug in the context of complex therapies (rifampicin and abciximab causing late onset thrombocytopenia).

Topics: Abciximab; Angioplasty, Balloon, Coronary; Anti-Bacterial Agents; Antibodies, Monoclonal; Anticoagulants; Autoantibodies; Ciprofloxacin; Drug Therapy, Combination; Flow Cytometry; Humans; Immunoglobulin Fab Fragments; Immunoglobulin G; Male; Middle Aged; Myocardial Infarction; Osteomyelitis; Purpura, Thrombocytopenic, Idiopathic; Rifampin

Brucellosis continues to be an important cause of fever in underdeveloped countries and in rural areas of developed world. It is a multisystemic disease, associated with wide variety of symptoms. A wide variety of symptoms, including haematological abnormalities, such as anaemia, thrombocytopenia, pancytopenia, dissemine intravascular coagulation and leucopoenia could be seen, all of which are more common than usually thought. In this short study, we present a relatively uncommon haematological manifestation that of isolated thrombocytopenia mimicking idiopathic thrombocytopenic purpura, which we observed in seven of 114 patients who were diagnosed with brucellosis in our hospital over a 2-year period. Having given brucellosis treatment with rifampicin and doxycycline, complete remission was achieved and thrombocyte count returned to normal in all cases.

Topics: Adult; Aged; Antibiotics, Antitubercular; Brucellosis; Diagnosis, Differential; Doxycycline; Female; Humans; Male; Middle Aged; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Thrombocytopenia

Topics: Adrenal Cortex Hormones; Antineoplastic Combined Chemotherapy Protocols; Antitubercular Agents; Asparaginase; Comorbidity; Daunorubicin; HIV Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; India; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Purpura, Thrombocytopenic, Idiopathic; Retrospective Studies; Rifampin; Thrombocytopenia; Tuberculosis; Vincristine

Topics: Anti-Bacterial Agents; Antitubercular Agents; Autoimmune Diseases; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Lymph Nodes; Middle Aged; Mycobacterium tuberculosis; Purpura, Thrombocytopenic, Idiopathic; Pyrazinamide; Pyridoxine; Rifampin; Tuberculosis

Thrombocytopenia is a major adverse effect of several drug treatments. Rifampicin has been recognized as a cause of immune thrombocytopenia during intermittent high-dose therapy. We characterized the antibody of a patient who presented with purpura and thrombocytopenia during treatment of tuberculosis with rifampicin. Drug-dependent binding of the antibody to platelets was demonstrated by flow cytometry. In a glycoprotein-specific immunoassay, the binding epitope of the IgG antibody was found in the glycoprotein Ib/IX complex, using four different monoclonal antibodies (mAbs) against various epitopes on the GPIb/IX complex, as well as mAbs against GPIIb/IIIa, GPIa/IIa and GPIV. By immunoprecipitation of biotin-labelled platelets, reactivity of the antibody with GPIb/IX was found only in the presence of the drug. These findings clearly demonstrate that rifampicin induces the formation of drug-dependent antibodies capable of causing thrombocytopenia. The binding site of the rifampicin-dependent antibody, located in the GPIb/IX complex, seems to be a favoured target for antibodies induced by different drugs.

Topics: Adult; Antibiotics, Antitubercular; Antibodies, Monoclonal; Antigen-Antibody Reactions; Blood Platelets; Epitope Mapping; Epitopes; Flow Cytometry; Humans; Immunoglobulin G; Male; Platelet Glycoprotein GPIb-IX Complex; Precipitin Tests; Purpura, Thrombocytopenic, Idiopathic; Rifampin